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OAL <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> col _-- --- <br /> Z5 2 3610 I Fax 425,25r#45T i EI avers eos <br /> (Blue or Black tisk- P riO ttwa povl w,'avareowa.guviparmi!s <br /> Y Please) PROJEOT SITE=1Na oitMkYIbN _ q It;t:-' <br /> On! <br /> PROJECT SITE ADDRESS: e 1` <br /> IN; PROPERTY TAX p: <br /> LEGAL roc now <br /> rt:fon:Shier--t:;;;hd:c;an <br /> - i:ot No. (•tach copy a long[eget description) <br /> CONTACT <br /> OWNER NAME: { t' ' <br /> A- 1 i ri •i. TENANT NAME(If Comm arms): <br /> OWNER MAILING ADDRESS: .'n-) ‘O, ile1 1: .. rf <br /> OWNER PHONE: 2.0c. q l-'i ...0 .i: oasis <br /> .r H aw r:: s o•. <br /> OWNER EMAIL:. . <br /> CONTRACTOR NAME: <br /> w> 101 y1 C <br /> CONTRACTOR ADDRESS: ST,FET 14a <br /> CONTRACTOR PHONE: q SWF r„ •. • <br /> Io ...0 CONTRACTOR EMAIL i, 0 Ai 5, ' AA t st I nit 4 0 <br /> PRIMARY CONTACT: ❑OWNER 4�r �+spit <br /> w D��memEUStNEStSti,ehac-8(REQTiMRED ' <br /> CJNTRAOTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> -D `YiC„o a- CONTACT PHONE: i425 2! Q1 r,, <br /> C <br /> .LLeJ CONTACT EMAIL: ��Ar�a ' keo, • 'Co <br /> r "4rISUILDING'PEtott`I"3AC.Qt`•'LION "'* 'r;. -�.-P,;' <br /> E>astin.Use of auNtli., <br /> Contract Price of Work:S d ra 0 <br /> Dui-Idle T..a:Mtln•QSfR•Data11 ❑S=PA!ta;,liarl G -a GElechic DOther _ .... ._ <br /> ❑Dupla$ ❑MGlll.i:amll#of nits: �� <br /> T as of Project:❑Naw ❑Aydition ❑Romolo ion IX:rcial ❑industrial J <br /> DESCRIPTION DF WORK; ❑R'-p�--- 31QL! L�3€.n ❑gprinkl^_r ❑Damolitian ❑C <br /> .Of IJa9 <br /> .......... <br /> )140.cX... 6- S -cu9Y1AC52..- <br /> ASSOCIATED BUILDING PERMfT N flf dc,i1Sable): <br /> ' ''r PLIJM N P Md ,. <br /> x`77 �( a .ERM IY'.A_Alt ittioN <br /> ration <br /> _, �1� Type of Protect _New _Add, _Alteration _Repair <br /> N <br /> NCNNW -ASr Handle ;� P7e 1 res. 4JW dfPioE tea= N oI <br /> Un,fs . MIMI Toilet <br /> Flsfures 'e a,85I0r In r_ <br /> Mairm _NMI Bathtub Backflow Prevenler Inside aid <br /> _Water Heater Boileral IEZEMEEZmaN111.1111a7 Lava:.+ Urinal <br /> _ Wash Basin Floor r Fountain <br /> ': _Shower Flocs Drain- <br /> Wood Stove _Ote hen Stnk&Dfs..sal <br /> Clothes 0 er ®OtherGrease r <br /> Hook �gIfflum.Other. _Clsnwashar rep <br /> Ra ,a Hoon <br /> Roof Drains <br /> _Clgthes Washer Medtrai Gas <br /> aim ®� Water Heater Dinars <br /> -� Sink Sarvkal&ariM..etr„ OtF:er. <br /> ACl( ammilinill <br /> � GEAf� � <br /> A CXN 7 d phis apphcelkn and comet.the Inbnnerb,conlelned herds AWe end carred.Work done <br /> edera4 State,end tical law.The grading cr a pemll eMy eonIO zes...Meer/wok end no devfaflons therefrom, <br /> a�+o n4#wen <br /> ochre tale ontracsor,under 27 RCW and 29 I CC the pursuant to this pemel must ccmp,, � <br /> are I comply tel bee State CU hMiLes Lew 18.27 owner,erl am eW:edaed t the ol'ege,0 prover hat be kr ed a wnene neehorn Inn <br /> RCW and lge,2GGA WAC. <br /> Y owner Properly fa lreN the work hr whch• ' <br /> FPac+lbr:is netle, <br /> CCy of&malt Official Use Croy <br /> '.,®lAt ,s.... }J a •3o .15 PER (� <br /> ' � I <br /> r7AVtitOAzed A9 Signature <br /> Dale - • p,ievr n 912 /6) <br />